Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Thursday, March 28, 2013

A small news item from the Seattle public radio station, KUOW, provides our latest example of the contrasts between how hired executives and "regular" employees are treated even at non-profit health care organizations, and between these organizations' actions and their stated missions.

Hospital Employees Strike Against Reductions in their Health Insurance

The report was about a small job action going on at a single hospital. Ironically, the strike is over the employees' own health insurance.

Along
with housekeepers, nursing assistants and other staff, surgical
technologist Bob Wilson is a member of the Service Employees
International Union local 1199NW.

'You see all the guys on TV
that hand the doctor the scalpel? That’s me,' he said from the picket
line on Friday. 'We’re out here because we think we deserve affordable
health care.'

The union and Providence St. Peter have been in
contract negotiations since last summer. SEIU represents about one
fourth of the hospital's employees.

In January, employees' health
insurance changed. The union says the higher deductibles and out of
pocket expenses hurt for a union whose median member makes $31,000 a
year.

I’m forgoing care,' Wilson said. 'I’m not going and seeing
a doctor unless I absolutely have to. A lot of people here at
Providence are doing the same thing: They’re trying to save their
money.'

An piece on the Huffington Post further described the strikers' concerns about the new health plans' deductible amounts:

The
employees' new $3,000 annual deductible for families is 10 percent of
the average worker's pay and a sharp boost from the $750 yearly
deductible in their previous health plan.

Millions for Hired Managers

The first contrast is between the strikers' relatively low pay and modest insurance coverage with the compensation given to the hospital system's top managers. Per KUOW,

Providence St. Peter is part of Providence Health & Services. The
Catholic organization runs hospitals in five western states. Its
headquarters is in Renton.

Furthermore,

The union says Providence can afford to do better given what it pays its CEO, John Koster.

The
union just learned of Koster’s 2011 pay on Thursday after reading
Providence’s latest filing with the IRS. Providence reported Koster’s
compensation as $6.4 million, up from $3.1 million in 2010.

Also,

Providence’s IRS filing reveals that 19 employees of the Catholic
ministry earned at least $1 million in 2011. Eight of those employees
earned at least $2 million. The top five executives earned more than $3
million each.

Note further that the organization's filing acknowledged that some of its most highly compensated employees received "first-class or charter travel," "tax indemnification and gross-up payment[s]," discretionary spending account[s]," "housing allowance[s] or residence[s] for personal use," and "payments for business use of personal residence."

Providence Health & Services is a not-for-profit Catholic health
care ministry committed to providing for the needs of the communities it
serves – especially for those who are poor and vulnerable. Providence
Health & Services continues a tradition of caring that the Sisters
of Providence began more than 155 years ago.

It does not seem unreasonable to claim that low level employees making about $31,000 a year given a health plan with a $3,000 deductible are likely to become poor and vulnerable were they to be unlucky enough to sustain any major illness or injury.

The Market Made Us Do It

However, instead of considering its mission, Providence Health & Services spokespeople invoked the market as justification for its less than generous health plan versus its exceedingly generous pay of top managers.

In an email to KUOW,
"Providence officials" described its contract offer and health plan as
"competitive with other health care providers."

Regarding its compensation practices,

In an email, Providence spokeswoman Colleen Wadden said Providence sets
its compensation the same way, whether it’s for housekeepers or
executives: Base salaries are set at the middle of the market.

Note that we have discussed the "market made me do it" justification for huge executive compensation from health care organizations as a talking point that is used again and again by public relations operatives and board members (e.g., look here). Its use in this case, though, is particularly unfortunate.

Summary

In this example, we have a huge health system (with over $3.6 billion in revenue in 2011) whose mission is to be a "Catholic health care ministry" that serves the "poor and vulnerable" also claiming that the almighty market means it must pay its executives more than one hundred times what it pays its lowliest employees, compensate them with first class travel, tax gross-ups, and so forth. Moreover, presumably this dictatorial market also makes sure this ministry cannot provide its lowliest employees with health insurance that seems sufficient to prevent them from becoming poor and vulnerable should a severe illness strike.

Maybe Providence Health & Services executives and public relations people should read what one prominent Catholic theologian wrote (here, and see this post) about the market in health care:

Hospitals and other facilities 'must rethink their particular role in order to avoid having health become a simple 'commodity,' subordinate to the laws of the market, and, therefore, a good reserved to a few, rather than a universal good to be guaranteed and defended,'

That theologian was the current Pope Emeritus, Benedict XVI.

So this is a new, vivid example of how leaders of big health care organizations may preach about the mission while acting to put their own self-interest way ahead of that mission.

As we have said until blue in the face,...

Health care organizations need leaders that uphold the core values of health care, and focus on and are accountable for the mission, not on secondary responsibilities that conflict with these values and their mission, and not on self-enrichment. Leaders ought to be rewarded reasonably, but not lavishly, for doing what ultimately improves patient care, or when applicable, good education and good research. On the other hand, those who authorize, direct and implement bad behavior ought to suffer negative consequences sufficient to deter future bad behavior.

If we do not fix the severe problems affecting the leadership and governance of health care, and do not increase accountability, integrity and transparency of health care leadership and governance, we will be as much to blame as the leaders when the system collapses.

2 comments:

Ross
said...

That isn't the only noteworthy thing that Catholic administered healthcare is doing in Washington state (and if they are doing it here it must be happening elsewhere around the country). They have been acquiring hospitals and clinics in parts of the region such that Catholic affiliated institutions are the only options and then imposing their values on the communities greatly affecting options for reproductive health and end of life care.

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